Articles by JCS

Dr. Gupta's Weed


September 17, 2013

TO:    Jeffrey Zucker, president of CNN Worldwide

Dr. Sanjay Gupta, CNN Chief Medical Reporter

Richard Davis, CNN EVP of News Standards and Practices

Val Willingham, CNN Medical Producer

CNN Headquarters

One CNN Center

Atlanta, GA 30303

 

RE:   Op-Ed: Dr. Gupta’s Weed & Other Controversies

(word count: 1541)

 

Dear Gentlemen:

Let me applaud CNN’s chief medical reporter, Sanjay Gupta, MD, for changing his mind about medical marijuana:

“Recently, I have apologized for some of the earlier reporting because I think we've been terribly and systematically misled in this country for some time.
And I did part of that misleading.”[1]

           Upon hearing his mea culpa, I thought if Dr. Gupta can apologize for misleading viewers about the health benefits of weed, maybe he can do the same about misleading his viewers about the health benefits of chiropractic care.

Redeeming CNN

Such a fair reassessment is not unprecedented considering two organizations of prominence—the AMA and Emory University—have apologized to their past victims of discrimination:

Nor is another apology uncalled for in regards to chiropractic care. On June 25, 2008, Dr. Gupta reported @ CNN.com, Stroke After Chiropractic Care: “Hundreds of people have had strokes after having their necks manipulated” despite research to the contrary showing this remote likelihood as well as the overall safety of spinal manipulation.[4]

On Nov. 18, 2012, Dr. Gupta did an exposé entitled, Deadly Dose, requested by former President Clinton, about deaths from opioid painkillers taken primarily for chronic back pain. Unfortunately, Dr. Gupta overlooked the most obvious non-drug solution to back pain, chiropractic care, as “a way to prevent people from taking a deadly dose” for millions of CNN viewers who would have been helped immeasurably by this mention.

Poster Child for Inefficient Spine Care

Larger newsworthy issues also have been virtually ignored @ CNN.com about the worldwide pandemic of back pain and the growing clamor in the news about controversial medical spine treatments. Articles in The New York Times, USA Today, and The Wall St. Journal over the last few years continue to reveal the dangers, expense, and abuse of spine surgery, opioid painkillers, and epidural steroid injections:

Mark Schoene, editor of The BACKLetter, an international spine research journal, summarized the research consensus best when he simply stated: “Spinal medicine in the US is a poster child for inefficient spine care.”[5]

Even the North American Spine Society admits spine surgery is “a last resort and should be considered only after other conservative (nonsurgical) measures have failed.”[6] The Spine Journal stressed that spinal manipulation in particular should be considered before surgery because research found it to “achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions.”[7]

Anthony Rosner, PhD, echoed this call for chiropractic care when he testified before The Institute of Medicine:

“Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[8]

Surveys have shown that chiropractors also have vaulted to the front in polls done by Consumer Reports[9], Gallup[10], TRICARE[11], and Medicare[12] of patients who were “very satisfied” with their chiropractic treatments.

Due to the dearth of news coverage, however, few people realize chiropractors are now the third-largest physician-level providers practicing in 90 countries around the world as the portal-of-entry (POE) for musculoskeletal disorders.

Paradigm Shift in Spine Care

Neurologist Scott Haldeman, MD, DC, PhD, a world-renown multi-disciplinary researcher from UCLA, confirms that “virtually all guidelines” on spine care now advocate conservative care first:

        “The paradigm shift has already taken place. Non-surgical, non-invasive care is already the first choice for treatment for spinal disorders in the absence of red flags for serious pathology in virtually all guidelines.”[13]

This paradigm shift essentially began over twenty years ago with game-changing research undermining the customary abnormal disc diagnosis. Dr. Gupta is uniquely aware of this issue both as a neurosurgeon and as an Emory University colleague of Scott Boden, MD, director of the Spine Center at Emory, whose seminal MRI research in 1990 debunked the underlying “bad disc” premise upon finding many pain-free people in his study had herniated or degenerated discs.[14]

This issue recently became a topic in the news except @ CNN:

Worsening Trends

Research has also revealed other problems in spine care. Scott Boden, MD, confessed that “many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”[16]

Moreover, patients do not realize that half of all medical schools do not even teach one class in musculoskeletal disorders.[17] Consequently, most medical primary care physicians (PCPs) are deemed “inept” in their academic training on musculoskeletal disorders,[18] more prone to be “naïve prescribers” as Dr. Gupta mentioned,[19] and most PCPs were found to be more likely to suggest spine surgery than even surgeons themselves.[20]

The ineffectiveness of medical spine care diagnosis and treatments has now burst onto the national scene with a flurry of yet more articles after a recent July 29, 2013, investigation in the JAMA Internal Medicine highlighted the Worsening Trends in the Management and Treatment of Back Pain. The authors of this study admit, “Back pain treatment is costly and frequently includes overuse of treatments that are unsupported by clinical guidelines.”

This article went viral overnight in the mainstream media except @ CNN.com:

Helping Millions, Saving Billions

Spine surgeons worry as insurance payers become more wary because stunning new research continues to show that fusion surgery has no advantage over non-surgical care for patients with chronic back pain and disc degeneration over the long-term (11 year) follow-up, according to Anne Mannion, PhD, et al.[21]

As a result, some payers such as North Carolina Blue Cross/Blue Shield have announced they will no longer pay for spine fusion if the sole criterion is an abnormal disc that is now considered to be solely a clinical finding, but not a diagnosis.[22]

The new guidelines will help patients avoid surgery as well as lower medical costs. For example, a recent workers comp study from Washington State compared patients with low back pain whose first provider was either a chiropractor or a surgeon. This produced drastically different rates for surgery: 42.7% of workers who first saw a surgeon had surgery in contrast to only 1.5% of those who first saw a chiropractor.[23]

This study illustrates when modern, well-educated chiropractors assume their rightful POE role as America’s primary spine care providers (PSP)[24] and patients are allowed the choice to a “proven treatment”[25] for this pervasive pandemic of back pain, the potential benefits for the payers will be enormous saving billions of dollars in total costs from “inefficient” medical spine care, lost wages, and disability.

Call to Action

As “the most trusted name in news,” I urge Dr. Gupta and medical producer Val Willingham to embrace CNN’s motto by producing an objective exposé similar to Deadly Dose, perhaps titled Helpful Hands, about the paradigm shift in spine care citing the new evidence-based guidelines, the controversies surrounding inefficient medical spine care, and the emerging support for chiropractic care.

If Dr. Gupta is willing to come out of the closet about weed, then it’s time for CNN to come clean about other skeletons in the medical closet. Similar to the emergence of gays, lesbians, blacks, and women, this is another fascinating human interest story about a healthcare minority just waiting to be told. Indeed, it’s past time for chiropractors to come out of the medical closet, too.

Regards,

JC Smith

www.chiropractorsforfairjournalism.com

cc:    Georgia Chiropractic Association

        American Chiropractic Association

        Life University President Guy Riekeman

        Foundation for Chiropractic Progress

 



[1] Piers Morgan, August 7, 2013, Host Piers Morgan and guest Dr. Sanjay Gupta discuss marijuana

[2] Kevin B. O’Reilly, AMA apologizes for past inequality against black doctors, amednews staff, July 28, 2008

[3] Karen Fox, Emory apologizes for history of anti-Semitism at dental school, ADA News Staff, November 19, 2012

[4] AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, (2001)

[5] The BACKPage editorial, vol. 27, No. 11, November 2012.

[6] “Spinal Fusion,” North American Spine Society Public Education Series,  www.spine.org/documents/fusion 

[7] MD Freeman and JM Mayer “NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain,” The Spine Journal 10/10 (October 2010):918-940

[8] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.

[9] “Relief for Aching Backs:  Hands-on Therapies were Top Rated by 14,000 Consumers,” Consumer Report (May 2009)

[10] The Gallup Organization, Democratic Characteristics of Users of Chiropractic Services (Princeton, NJ:  The Gallup Organization (1991

[11] Chiropractic Care Study, Senate Report 110-335 accompanying the National Defense Authorization Act for FY 2009; letter sent to Congressmen by Ellen P. Embrey, Deputy Assistant Secretary of Defense (September 22, 2009):2.

[12] WB Stason, G Ritter, DS Shepard, C Tompkins, TC Martin, S Lee, “Report to Congress on the Evaluation of the Demonstration of Coverage of Chiropractic Services Under Medicare,” (June 16, 2009)

[13] Private communication with JC Smith, 7/10/2013

[14] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans Of The Lumbar Spine In Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

[16] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28 (2003):524-525.

[17] Matzkin E, Smith MD, Freccero DC, Richardson AB, Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005, 87-A:310-314

[18] Elizabeth A. Joy, MD; Sonja Van Hala, MD, MPH, “Musculoskeletal Curricula in Medical Education-- Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/ 11 (November 2004).

[19] PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.

[20] SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, And Surgeons For Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.

[21] MannionF et al., A comparison of spinal fusion and non-operative treatment in patients with chronic low back pain: An average 11-year follow-up of three randomized controlled trials, presented at the annual meeting, International Society for the Study of Lumbar Spine, The Spine Journal, 2012. In press.

[23] Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM., Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State, Spine (Phila Pa 1976). 2012 Dec 12

[24] Donald R Murphy, Brian D Justice, Ian C Paskowski, Stephen M Perle, Michael J Schneider, The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States, Chiropractic & Manual Therapies 2011, 19:17

[25] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)

Website Builder